Parkinson’s and Parkinsonian Disorders: Why PT?

I will always say that knowledge is power, and with Parkinson’s and all of its close relations, this is especially true. Understanding how Parkinson’s affects the brain and why symptoms are occurring can help us better understand what we can do about it, how medication and treatments work, and why therapy is such a big part of the picture!

Various Parkinsonian disorders have some of their primary effects in an area of the brain known as the Basal Ganglia. This area of the brain relies heavily on a substance called dopamine to do its job. The names, however, aren’t what are important. The function is! The Basal Ganglia is the part of our brain that helps us do without thinking. When you decide to pick up a cup of water, your brain has stored a pattern in it for which movements are required. More than that, it can recognize from experience how much that glass should weight, and therefor how much force it should be applying. We have all had an instance where this system has made an error: have you ever pick up a glass thinking there was more water in it than there really was, and you launched it so fast up that what was left in the glass went everywhere? That is an overestimation from the Basal Ganglia! Just a rather embarrassing one.

The amount of effort we put into a movement is remembered and controlled partially here, in the Basal Ganglia, and the sensitivity and amount of dopamine that this area receives helps us make a big enough or small enough step when we walk, helps us talk at a normal volume without thinking about how loudly we are speaking, and helps us adjust even the small movements required to maintain a steady position in standing so we don’t fall. To boot, it does all of this unconsciously so that our brain can focus on other things!

So what happens when this area of the brain isn’t working as well? Well, if our body is not producing as much dopamine, or does not use it as well, the degree of our unconscious actions often becomes smaller than it used to be. Long confident strides become short shuffling steps, big smiles become blank expressions, and just standing upright ends up leaning forward and off balance. These common symptoms of Parkinson’s disease, because they come from an area of the brain that is usually unconsciously controlled, often go unnoticed by a patient whose brain feels like it is working the same. You feel as if you are talking at a normal volume because your brain is sending the same message it always used to, but because of the changes in the Basal Ganglia, the result is smaller.

So what do we do? Well, a common line of defense is dopamine replacement. Various medications and pumps can be used to help the brain utilize or receive the normal amount of chemicals needed for this area of the brain to work exactly like it used to, which is why someone starting a properly dosed medication can have such a sudden change!

The good news is, beyond the medication there is even more. Our body has a very “redundant” system, meaning that it is designed such that if one pathway to an action is damaged, another can pick up the slack and take over. The same is true in Parkinson’s! If the unconscious pathway to measuring the output of an action is not working like we are used to, we can use the conscious network. Instead of relying on our brain to just know if our steps are big enough, looking for visual cues like seeing if our heels come forward of our toes when walking, can allow us to make the conscious corrections we previously relied on the Basal Ganglia to make for us!

This is the job of Physical Therapy, we take a look at those movements that are smaller than expected and help the conscious brain learn to make the size corrections it might be missing, meaning that balance, voice, walking, even standing up and turning around can be changed by looking for and using the right cues! If we know the pathways involved, we can find back roads to get to our destination, and get everyone back on course to moving like they want to. The even better news is that the earlier you can get to work on this, the easier it seems to come as well, so there is no wrong time to start looking at your movements and relearning!

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